title: [Double Wenckebach phenomenon at nodal and His levels. Electrophysiological demonstration in slow and irregular flutter].
abstract: The authors describe the analysis of a case of atrial flutter with a slow ventricular response, the block being 9:2 with a first RR interval measuring between 3 and 4 PP intervals and a second RR interval between 5 and 6 PP intervals, the second of the 2 RR intervals being exactly 9 PP intervals. The only possible explanation of this sequence is firstly a 3:1 intranodal block (Wenckebach 3:2 in the central zone N of the node and 2:1 block at the nodo-hisian junction) followed by a 3:2 infra- or intra-hisian Wenckebach phenomenon. The His bundle recordings during flutter confirmed this hypothesis with the recording of a 3:2 block after the H potential. When sinus rhythm was restored at atrial level, the intrahisian conduction defect persisted (2:1 or 3:2 Wenckebach block).
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000503:physiopathology*; D001283:Atrioventricular Node / Q000502:physiology / Q000503:physiopathology*; D002036:Bundle of His / Q000503:physiopathology; D004594:Electrophysiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000503:physiopathology*; D006801:Humans; D008297:Male; D013997:Time Factors
vernacular_title: Double phénomène de Wenckebach, nodal et hisien. Démonstration électrophysiologique dans un flutter lent et irrégulier.